Steroid-induced osteoporosis

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Steroid-induced osteoporosis (SIOP) is osteoporosis arising due to use of glucocorticoids (steroid hormones) - analogous to Cushing's syndrome and involving mainly the axial skeleton. The synthetic glucocorticoid prescription drug prednisone is a main candidate after prolonged intake. Bisphosphonates are beneficial in reducing the risk of vertebral fractures.[1] Some professional guidelines recommend prophylactic calcium and vitamin D supplementation in patients who take the equivalent of more than 30 mg hydrocortisone (7.5 mg of prednisolone), especially when this is in excess of three months.[2][3] The use of thiazide diuretics, and gonadal hormone replacement has also been recommended, with the use of calcitonin, bisphosphonates, sodium fluoride or anabolic steroids also suggested in refractory cases.[4] Alternate day use may not prevent this complication.[5]

Mechanisms of SIOP include:[6]

  • Direct inhibition of osteoblast function
  • Direct enhancement of bone resorption
  • Inhibition of gastrointestinal calcium absorption
  • Increased urine calcium loss
  • Inhibition of sex steroids


  1. ^ Allen, CS; Yeung, JH; Vandermeer, B; Homik, J (5 October 2016). "Bisphosphonates for steroid-induced osteoporosis.". The Cochrane database of systematic reviews. 10: CD001347. PMID 27706804. 
  2. ^ Bone and Tooth Society of Great Britain, National Osteoporosis Society, Royal College of Physicians (2003). Glucocorticoid-induced Osteoporosis (PDF). London, UK: Royal College of Physicians of London. ISBN 1-86016-173-1. 
  3. ^ Cochrane Reviews. [url= "Calcium and vitamin D for treating osteoporosis caused by the use of steroids"]
  4. ^ Lukert, Barbara P. (1 March 1990). "Glucocorticoid-Induced Osteoporosis: Pathogenesis and Management". Annals of Internal Medicine. 112 (5): 352. doi:10.7326/0003-4819-112-5-352. 
  5. ^ Gourlay M, Franceschini N, Sheyn Y (2007). "Prevention and treatment strategies for glucocorticoid-induced osteoporotic fractures". Clin Rheumatol. 26 (2): 144–53. doi:10.1007/s10067-006-0315-1. PMID 16670825. 
  6. ^ Steroid-induced osteoporosis By Susan Ott, MD. Updated January 28, 2009. Retrieved on 26 March 2009